Page 44 - Clinical relevance of current materials for cranial implants

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Chapter 2
Costs
Twenty-one studies reported costs, ranging from implant cost to total medical expenses. PMMA implants were less expensive than PEEK and titanium implants. The least-expensive PMMA implant was 35 GBP64, the most expensive PMMA implant was 1300 USD after 3D printing65. The costs of PEEK ranged from 5000 USD66 to 20,522 USD67. Titanium cranioplasties cost between 2000 GBP64 and 5050 EUR55. Total surgery costs for PSIs of PEEK and titanium were reported to be 15,532 EUR (of which 10,000 EUR for the implant), compared with 10,849 EUR for autologous replacement68. Gilardino et al.69 reported a total cost of 28,560 USD for treatment with PEEK, whereas autologous treatment costs were 25,797 USD.
Esthetic outcome
Most patients were satisfied or highly satisfied with the eventual esthetic outcome. All of the studies reporting both patient and clinician satisfaction showed they were in agreement.
Quality of Life
Five studies reporting the QoL showed an improvement after cranioplasty. Manrique et al.58 reported that 3 of 4 patients had returned to a similar state as before the skull defect, whereas 1 patient reported dissatisfaction with his appearance and had an overall fair QoL as measured with the Head and Neck Outcome Questionnaire from the University of Washington. Lindner et al.12 used the short-form-36 questionnaire to evaluate the subjective QoL and stated patients treated with a titanium or HA cranioplasty were “more satisfied at the end of the study than at the beginning”. Moser et al.52 described that 82.4% of the patients had an improved QoL postoperatively, based on 10 easy-to-understand questions in the German language. Cabraja et al.55 showed all patients had a “considerable improvement in their QoL following calvarial reconstruction” and would “undergo cranioplasty again”. Also Kamyszek et al.46 noted a “clear positive trend” in QoL and 85% of patients “would undergo the procedure again”.